HIV cure: The daunting scale of the problem

Combination antiretroviral therapy (ART) for HIV-1 infection reduces plasma virus levels such that clinical assays for viremia are negative. Because of unexpected cooperativity in dose-response relationships and drug synergies, ART completely inhibits new infection events, halting viral evolution and disease progression. However, ART is not curative owing to a persistent latent reservoir of HIV-1, the half-life of which is long enough to guarantee lifetime persistence, even with optimal ART. Within weeks, interruption of ART leads to rebound viremia, with subsequent disease progression toward fatal immunodeficiency. Therefore, lifelong ART is necessary. People who acquire HIV-1 during their 20s face 50 to 60 years of continuous treatment with multiple antiretroviral drugs. Children infected perinatally face a lifetime of treatment. Thus, there is a pressing need for a cure, which, in a practical sense, amounts to preventing viral rebound after ART interruption. Present efforts focus on eliminating the reservoir.

Read a perspective, published in Science, further elaborating on the present HIV cure strategies.